PRIMARY GASTRIC NON-HODGKINS-LYMPHOMA STAGE IE AND IIE

The aim of this study was to evaluate retrospectively the different tr eatment approaches and outcome of patients with stage IE and IIE gastr ic non-Hodgkin's lymphoma in a cancer registry. Between 1982 and 1992, the Comprehensive Cancer Centre South (CCCS), Eastern Section, The Ne therlands, registered, in a population of 1 million people, a total of 81 cases of gastric lymphoma stage IE and IIE (43 men and 38 women). Median age was 69.7 years (range 30.4-88.1). According to the Working Formulation, the malignancy grade was: 9 low, 55 intermediate and 14 h igh. According to the MALT classification, the malignancy grade was: 3 8 low and 40 high. Grade was unknown in 3 patients. Patients received the following treatment modalities: surgery alone (n = 22), locoregion al radiotherapy without (n = 12) or with (n = 13) surgery; or systemic chemotherapy alone (n = 10) or with radiotherapy and/or surgery (n = 18). No treatment was given or recorded in 6 patients. For stage IE, 5 -year actuarial survival and relapse-free survival rates were, respect ively, 76 and 64% in 18 patients who received only surgery; 70 and 67% in 17 patients given locoregional treatment (radiotherapy with or wit hout surgery), and 76 and 62% in 13 patients given systemic treatment (chemotherapy alone or with radiotherapy and/or surgery). Radiotherapy as sole treatment seemed to be as effective as other treatment modali ties in achieving local and abdominal control. For stage IIE, none of the 4 patients who were treated with surgery alone survived 5 years. T he 5-year actuarial survival and relapse-free survival rates of 8 pati ents who received radiotherapy with or without surgery were, respectiv ely, 25 and 17% and 49 and 33%, for 14 patients given systemic therapy (chemotherapy alone and/or radiotherapy/surgery). In stage IIE, local , abdominal as well as distant relapse were more common, irrespective of treatment modality. In the multivariate analyses, stage (P = 0.002) , grade (P = 0.02), age (P = 0.04) and gender (P = 0.04) were signific ant prognostic factors. This report on a limited number of patients sh ows that the outcome of patients with stage IIE gastric lymphoma is mu ch worse than for patients with stage IE, Grade, age, gender and parti cularly stage are much stronger indicators for survival than different modes of treatment. Systemic therapy might improve outcome for stage IIE, but not for stage IE, for which radiotherapy alone seems a good o ption. Copyright (C) 1996 Elsevier Science Ltd